PEARL OF WEST HILLS, INC

Official classification

Type A

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above by not ensuring a qualified administrator or designee was responsible for facility operations today which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will return to the facility on Sunday, 06/29/25 to ensure responsible operations of the facility.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in Staff #1 (S1) caring for residents without a criminal background clearance associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction Licensee will schedule associated staff to work in the facility until they return on 06/29/25.

Official classification

Type A

Official code

87411(d)

Regulation authority

CCR

What the official deficiency says

(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above in allowing Staff #1 (S1) to care for residets without documented training which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will ensure only trained staff will work in the facility after today. The licensee will also provide S1 with all required initial trainings and submit proof of trainings by 07/12/25

Official classification

Type A

Official code

87606(c)

Regulation authority

CCR

What the official deficiency says

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above in exceeding the facility's fire clearance by placing two (02) bedridden residents in Bedroom #4 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will submit a written, measurable, and verifiable plan on the relocation of one (01) of the two (02) bedridden residents by the POC due date.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on interviews, the licensee did not comply with the section cited above in two (02) out of three (03) residents using full bed rails without physician orders which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction Staff #1 (S1) removed all full bed rails on bed's of residents without hospice or physician orders for full bed rails. The deficiency is cleared at this time.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above in two (02) out of three (03) residents with full bed rails without a hospice care plan which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction Staff #1 (S1) removed all full bed rails on bed's of residents without hospice or physician orders for full bed rails. The deficiency is cleared at this time.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above in one expired fire extinguisher in the kitchen which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/28/2025 Plan of Correction The licensee will replace the expired fire extinguisher by the POC due date and send a photograph of the new fire extinguisher.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observations and interviews, the licensee did not comply with the section cited above in not providing the staff file of Staff #1 (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/12/2025 Plan of Correction The licensee will provide keys and training to all staff in charge of facility operations to allow for the audit of all conficential files.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in two (02) out of three (03) water faucets which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/01/2024 Plan of Correction Licensee has agreed to lower the hot water temperature on the water heater and send proof of water temperature measured within regulations by POC due date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in one (01) out of two (02) employees which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee has agreed to provide proof of updated CPR certificate for Staff #1 (S1) and maintain in facility file by POC due date

Official classification

Type B

Official code

87412(a)(12)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Hazardous health conditions documents as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in one (01) out of two (02) employees which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee has agreed to provide proof of TB Test for Staff #1 (S1) and maintain in facility file by POC due date

Official classification

Type B

Official code

87456(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in two (02) out of three (03) resident medical assessments which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee has agreed to obtain current medical assessments for Resident #1 (R1) and Resident #2 (R2) and maintain in the faiclity file by the POC due date.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in one (01) out of one (01) which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2024 Plan of Correction Licensee agreed to obtain a new or recently inspected fire extinguisher for the kitchen by the POC due date.

Official classification

Type A

Official code

87608(5)(b)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation it was observed that resident #4 had a full bed rail and is not on hospice. This is an immediate health and safety risk to residents in care.

Official plan of correction

POC Due Date: 05/06/2022 Plan of Correction Administrator shall have bed rail removed on R4's bed. Administrator will contact R4's physician regarding bed rail

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Departmentr This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not ensuring staff 1 (S1) obtained criminal record clearance prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee stated that S1 would not be at the facility until proper criminal record clearance is granted for S1.

Deadline recorded: Mar 4, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

87406 Administrator Certification Requirements (g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. This requirement is not met as evidenced by: Based on review of records and interview with licensee which revealed the Licensees Administrator Certificate expired 08/08/2020 and the Administrator has not taken the required classes to renew the required Administrator Certificate which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Licensee/Administrator will notify the department when they will renew their certificate and who will be the designated administrator for the facility while she completes the renewal process.

Deadline recorded: Feb 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not transferring criminal record clearance for staff 1 (S1) to this facility prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee Irina Karbachinskiy provided transfer of criminal record clearance and photo ID to the LPA during the visit.

Deadline recorded: Nov 5, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Departmentr This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above by not ensuring staff 2 (S2) obtained criminal record clearance prior to employment which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee Irina Karbachinskiy requested for staff member to leave the facility. Licensee provided LPA a signed written statement that the staff # 2 will not return to the facility until criminal record clearance is obtained.

Deadline recorded: Nov 5, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87406(g)

Regulation authority

CCR

What the official deficiency says

87406 Administrator Certification Requirements (g) Certificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. This requirement is not met as evidenced by: Based on review of records and interview with licensee which revealed the Licensees Administrator Certificate expired 08/08/2020 and the Administrator has not taken the required classes to renew the required Administrator Certificate which poses an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

This deficiency was cited on 4/20/2021. As of todays visit Licensee Irina Karbachinskiy confirmed that she has not completed all of the required classes to renew her certificate. Licensee/Administrator will notify the department when they will renew their certificate and who will be the designated administrator for the facility while she completes the renewal process.

Deadline recorded: Nov 8, 2021. A deadline is not proof that correction was completed.